The Negative Impact of Maternal Perinatal Opioid Use on Neonatal Outcomes

Paul E. Croarkin, DO, MS^a; Teresa A. Rummans, MD^a; Kathryn M. Schak, MD^a,*; Jennifer L. Vande Voort, MD^a; Jennifer R. Geske, MS^c; Julia Shekunov, MD^a; Kriti D. Gandhi, MD^a; Mara G. Limbeck, BS^e; Magdalena Romanowicz, MD^a; Brian A. Lynch, MD^b; Eric R. Pease, DO, MBA^a; Jinal Desai, MD^d

Prim Care Companion CNS Disord 2021;23(3):20m02737

ABSTRACT

Objective: To compare outcomes among newborns of opioid-using and nonopioid drug–using mothers with those of control mothers who did not report substance use.

Methods: Using the Rochester Epidemiology Project, newborns diagnosed with drug withdrawal syndrome (per ICD-9 or ICD-10 codes) from January 2010 through June 2017 were identified. For mothers, data collected included age, race, drug use, number of prenatal visits, and results of the urinary drug abuse survey, meconium test, and self-report survey. Demographic and perinatal data collected for newborns included birth date; sex; Apgar scores at 1, 5, and 10 minutes; neonatal intensive care stay; and vital status. Controls (n = 771) were similarly selected in regard to sex, birth date, and county.

Results: Of 328 infants identified, 168 were born with opioid neonatal abstinence syndrome and 160 with a nonopioid withdrawal syndrome. Control mothers had more prenatal visits than mothers in the nonopioid and opioid groups. Newborns of control mothers had higher Apgar scores at 1 and 5 minutes than both substance-using groups. Opioid-using mothers were almost twice as likely to have newborns requiring intensive care and 3 times as likely to use benzodiazepines compared to the other substance-using mothers. Substance-using mothers had more premature babies than controls.

Conclusions: Prenatal opioid use is a substantial risk factor for prematurity. Newborns diagnosed with neonatal abstinence syndrome are at risk of perinatal complications. Mothers using opioids during pregnancy also tend to use other substances. Longitudinal research should clarify how prenatal substance use interacts with other risk factors during a child’s first years.

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